THERESA DIANE MADDOX MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125051851

License Status

CANCELLED

Business

First Name

THERESA

Middle

DIANE

Last Name

MADDOX

Suffix

Business Name

THERESA DIANE MADDOX MD

Original Issue Date

07/01/2006

Effective Date

07/01/2006

Expiration Date

06/30/2009

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006